Spontaneous Bleeding Associated with Ginkgo biloba

A Case Report and Systematic Review of the Literature

Authors

  • Stephen Bent MD,

    1. Osher Center for Integrative Medicine, University of California, San Francisco, Calif, USA
    2. Department of Medicine, San Francisco VA Medical Center, San Francisco, Calif, USA
    3. Department of Medicine, University of California, San Francisco, Calif, USA
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  • Harley Goldberg DO,

    1. Department of Family Practice, University of California, San Francisco, Calif, USA
    2. Division of Research, Kaiser Permanente Northern California, Oakland, Calif, USA.
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  • Amy Padula MS,

    1. Osher Center for Integrative Medicine, University of California, San Francisco, Calif, USA
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  • Andrew L. Avins MD, MPH

    1. Osher Center for Integrative Medicine, University of California, San Francisco, Calif, USA
    2. Department of Medicine, San Francisco VA Medical Center, San Francisco, Calif, USA
    3. Department of Medicine, University of California, San Francisco, Calif, USA
    4. Division of Research, Kaiser Permanente Northern California, Oakland, Calif, USA.
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  • None of the authors have any financial or other conflicts of interest to report regarding this study or this article.

Address correspondence and requests for reprints to Dr. Bent: General Internal Medicine Section, San Francisco VAMC, 111-A1, 4150 Clement St., San Francisco, CA 94121 (e-mail: bent@itsa.ucsf.edu).

Abstract

Background: Ginkgo biloba (ginkgo) is a herbal remedy used by over 2% of the adult population in the United States. Several review articles have suggested that ginkgo may increase the risk of bleeding.

Objective: To report a case of bleeding associated with using ginkgo, to systematically review the literature for similar case reports, and to evaluate whether using ginkgo is causally related to bleeding.

Data Sources: We searched MEDLINE, EMBASE, IBIDS, and the Cochrane Collaboration Database from 1966 to October 2004 with no language restrictions.

Review Methods: Published case reports of bleeding events in persons using ginkgo were selected. Two reviewers independently abstracted a standard set of information to assess whether ginkgo caused the bleeding event.

Results: Fifteen published case reports described a temporal association between using ginkgo and a bleeding event. Most cases involved serious medical conditions, including 8 episodes of intracranial bleeding. However, 13 of the case reports identified other risk factors for bleeding. Only 6 reports clearly described that ginkgo was stopped and that bleeding did not recur. Bleeding times, measured in 3 reports, were elevated when patients were taking ginkgo.

Conclusion: A structured assessment of published case reports suggests a possible causal association between using ginkgo and bleeding events. Given the widespread use of this herb and the serious nature of the reported events, further studies are needed. Patients using ginkgo, particularly those with known bleeding risks, should be counseled about a possible increase in bleeding risk.

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